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Pancreatic duct stones (PDSs) can be treated by electrohydraulic lithotripsy (EHL) under endoscopic retrograde cholangiopancreatography (ERCP) guidance [1, 2]. The availability of the digital single-operator cholangioscope (SpyGlass DS; Boston Scientific, Natick, Massachusetts, USA) [3, 4] allows EHL to be more easily performed. However, if patients’ conditions are complicated by main pancreatic duct (MPD) stenosis, EHL for PDSs under pancreatoscopy guidance may be challenging. Herein, we describe some technical tips for the use of EHL to treat a PDS with placement of a temporary 6-mm fully covered self-expandable metal stent (FCSEMS). A 49-year-old man was admitted to our hospital because of abdominal pain due to chronic pancreatitis. On computed tomography (CT) scanning, a pancreatic stone was seen in the pancreatic body. Stone removal under ERCP was therefore attempted. A duodenoscope (JF260V; Olympus Optical, Tokyo, Japan) was inserted into the ampulla of Vater, and an ERCP catheter (MTW Endoskopie, Düsseldorf, Germany) was inserted into the MPD. Pancreatography showed a tight stricture in the pancreatic head (▶Fig. 1 a) and a stone in the pancreatic body. Although balloon dilation was performed, it was not possible to achieve enough dilation. Therefore, to allow insertion of the pancreatoscope, placement of a metal stent (6-mm×6-cm, Niti-S Biliary S-Type Stent Long Suture; TaeWoong Medical, Seoul, Korea) was performed (▶Fig. 1b). After 1 day, with the FCSEMS fully expanded, the pancreatoscope was inserted into the MPD through the stent (▶Fig. 1 c; ▶Video1). The pancreatic stone could be clearly observed and EHL was attempted. An electrohydraulic shock wave generator (Lithotron EL27; Walz Elektronik GmbH) was used to generate shock waves of increasing frequency, which were applied as a continuous sequence of discharges during EHL. EHL was successfully performed and the stone was subsequently removed using E-Videos

Electrohydraulic lithotripsy for pancreatic duct stones under temporary 6-mm fully covered metal stent placement